Early short-term abdominal paracentesis drainage in moderately severe and severe acute pancreatitis with pelvic ascites
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Jie Huang1, Lei Li1, Ying Chen2
1Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
Insights
Early short-term abdominal paracentesis drainage (APD) in acute pancreatitis patients with pelvic ascites is safe and effective. This intervention reduced infections, hospital stays, and the need for rehospitalization or surgical procedures.
Area of Science:
- Gastroenterology
- Surgical Procedures
- Critical Care Medicine
Background:
- Acute pancreatitis (AP) is a serious condition.
- Pelvic ascites can complicate moderately severe and severe acute pancreatitis (MSAP/SAP).
- The role of early intervention for pelvic ascites in AP requires investigation.
Purpose of the Study:
- To evaluate the efficacy and safety of early short-term abdominal paracentesis drainage (APD) in MSAP/SAP patients with pelvic ascites.
- To assess the impact of APD on clinical outcomes, complications, and prognosis.
Main Methods:
- A prospective study involving 135 MSAP/SAP patients with early pelvic ascites.
- Patients were divided into two groups: Short-term APD (57 patients) and Non-APD (78 patients).
- Evaluated effects, complications, and prognosis, comparing outcomes between the groups.
Main Results:
- The Short-term APD group showed significant improvements in intra-abdominal hypertension relief, nutrition delivery, and reduced mechanical ventilation duration.
- Patients undergoing APD experienced shorter intensive care unit and total hospitalization stays.
- APD was associated with faster reduction in inflammatory markers, lower intra-abdominal infection rates, and fewer instances of residual fluid collections or rehospitalization.
Conclusions:
- Early short-term APD is a feasible and safe procedure for MSAP/SAP patients with pelvic ascites.
- APD effectively reduces clinical symptoms, intra-abdominal infections, and hospital stay duration.
- The intervention may also decrease rehospitalization rates and the need for surgical interventions.
Background:
We sought to evaluate the effect of early short-term abdominal paracentesis drainage (APD) in moderately severe and severe acute pancreatitis (MSAP/SAP) with pelvic ascites.
Methods:
A total of 135 MSAP/SAP patients with early pelvic ascites were divided into the Short-term APD group (57 patients) and the Non-APD group (78 patients). The effects, complications, and prognosis of short-term APD patients were evaluated.
Results:
The baseline characteristics in the two groups were similar. The target days of intra-abdominal hypertension relief, half-dose enteral nutrition, duration of mechanical ventilation, length of intensive care unit stay (in days) and total hospitalization (also in days) were all lower in the Short-term APD group than in the Non-APD group (P = 0.002, 0.009, 0.004, 0.006 and 0.019), while the white blood cell count and serum C-reaction protein level decreased significantly more quickly (P < 0.01 and P < 0.05), and the prevalence of intra-abdominal infection was also significantly lower (P = 0.014) in the former than the latter. No complications occurred in early APD patients, and the microbial cultures of pelvic ascites were all negative. In addition, patients with early APD presented fewer cases of residual wall-off necrosis or fluid collection (P = 0.008) at discharge and had a lower incidence of rehospitalization and percutaneous catheter drainage and/or necrosectomy (P = 0.017 and 0.009).
Conclusions:
For MSAP/SAP patients with pelvic ascites, the early short-term APD is feasible and safe to perform, and it can decrease clinical symptoms, reduce intra-abdominal infection and shorten the hospital stay. It may also reduce the incidence of rehospitalization and surgical intervention.
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